Incontinence & Pelvic Organ Prolapse

Incontinence

Urinary incontinence is defined as loss of urine that is involuntary and is severe enough to constitute a social or hygienic problem. Incontinence affects all ages and it gets more common as women get older.

Even though the majority of women do not complain or discuss incontinence, it is thought that it could affect up to 55% of women. Another study showed that only one third of women who have incontinence discuss their symptoms with their doctor.

Why don’t women discuss incontinence?

Many women suffer with incontinence on average up to 3 years before they report their symptoms, and many more women go longer than that. It is believed that the reason for under-reporting of urinary incontinence may be embarrassment, depression, and loss of self-esteem. Some women relegate their needs below their role of taking care of other family members and some women accept incontinence as a natural part of aging.

What causes urinary incontinence?

Even though the cause of urinary incontinence is unknown, there are some well established risk factors such as increasing age, pregnancy and child birth, and obesity. There has been a suggestion of a genetic link in some quarters, and sometimes the presence of pelvic organ prolapse increases the risk of incontinence.

Are all types of incontinence alike?

No, there are different types of urinary incontinence in women. However, two types are very common.

Stress incontinence-leakage of urine with physical activity such as running, jumping, laughing, sneezing and coughing. This may also happen during sex or when bending over. This is usually caused by weakness of the muscles at the neck of the bladder and it tends to be more common in younger women. Women who have had vaginal birth are 2.5 times more likely to have stress incontinence than those who have never been pregnant.

Urge incontinence-this describes incontinence when it is associated with frequency of urination and urgency. Many times it is difficult to make it to the bathroom on time and some women have some triggers such as hand washing, site or sound of running water, and getting home from trips. This tends to be more common in older women.

Some women will have a combination of these two types called Mixed incontinence.

What are my treatment options with incontinence?

Even though many women have had incontinence for some time, there are many options available.

Pelvic floor exercises are very important for treatment as it improves the weak muscles that may have contributed to the condition in the first place. Studies have shown that exercises performed with a trained physical therapist have a better outcome than those that are not.

Use of intravaginal support devices (pessaries) are also very helpful, particularly with stress incontinence that occurs in the athlete who needs temporary protection while playing tennis or golf, while jogging, or while performing aerobic exercises.

Surgery is another option. A majority of surgeries for women who have stress incontinence are performed on an out-patient basis, are minimally invasive, and have very good success rates. Medications may also be necessary for women who have urgency.

Women have many treatment options available. Incontinence is a very important issue to discuss with your medical provider as it very likely can be made a thing of the past.

Pelvic Organ Prolapse

This refers to the herniation of pelvic organs into or beyond the vagina. The organs that can fall into the vagina are the uterus, bladder, rectum and intestines. Occasionally, in women that have had a hysterectomy, the apex of the vagina could descend into the vagina or protrude through the vagina. These different prolapses have varying levels of severity and it is possible to have all of them together in the same patient.

Many women start to experience prolapse of pelvic organs with advancing age, with the majority of women having symptoms after the age of 40. The risk of prolapse increases with the number of children birthed. The risk in women who have four children increases about ten times over women who did not give birth. Other risk factors include women who have chronic constipation, women with jobs that involve heavy lifting, and menopausal women.

Women who have a prolapse may notice symptoms related to pressure such as a bulge, or they may have some urinary or bowel related issues. Some women may have sexual difficulties. The severity of symptoms does not always correlate with how advanced a prolapse is and many times the bulge or protrusion is more pronounced in the evening after a day of physical activities.

Many women will have no symptoms and in these women, treatment may not be necessary.

It is always appropriate to consider less invasive means of treatment with your provider before surgery is considered. The usual alternatives to surgery are pelvic floor exercises and physical therapy. Pessaries may be a good option and are worth considering. Avoiding constipation and maintaining a healthy weight can also help.

Pelvic floor exercises (Kegel exercises) have also been shown to be most effective when supervised by a physical therapist.